Psychological adjustment of patients with dentofacial deformity beforeand after orthognathic surgery

Abstract

Dentofacial deformities have an adverse impact on functional as well as

psychological wellbeing. Being highly visible, they may lead to a host of

psychological problems particularly in youths and young adults as concerns about

bodily identity and integrity are likely to be most prominent. Body image and

self-esteem have been noted to play an important role in adjusting to

disfigurement. Those who opted for corrective orthognatic surgery with realistic

expectations were found to have a higher level of satisfaction with the outcome of

the surgery. In contrast, undue and unrealistically positive aspirations towards the

surgery are implicated in increased post-operative psychological difficulties.

This study aimed to systematically document the variability of psychological

adjustment and study the predictors of well-being in individuals with dentofacial

deformity after orthognathic surgery.

Seventy patients pending to go through orthognathic surgery were recruited

from a university based dental hospital. Assessments of the patients’ overall

psychological condition and adjustment towards their dentofacial deformity were

conducted with standardized questionnaires and compared with similar

assessment conducted with control subjects. The patients’ motivations for

orthognathic surgery, psychological well-being, as well as expectations on the

outcomes of surgery were studied through individually conducted psychological

assessment interviews. Patients were re-assessed at 6 and 12 months after

surgery on their level of satisfaction toward the outcome of surgery as well as to

gauge possible changes in their psychological condition.

There was no excess of significant psychopathology in patients with

dentofacial deformity compared to the normal control group. However, as

predicted, people with dentofacial deformity were more dissatisfied with their

facial attractiveness. They also have more problems in interpersonal sensitivity.

In the patient group, functional impairment or disability was a lesser concern

compared to body image and presentation. Improvement of physical attractiveness

was a strong underlying motivation for treatment. Longitudinal data on patients’

level of satisfaction with the treatment outcomes and perceived benefits

associated with the improved facial esthetics will be further analyzed in the light

of their underlying psychological vulnerabilities or resilience. The results are

expected to cast light on factors that may affect patients’ satisfaction with the

treatment.

The results of the study confirmed that dissatisfaction with facial appearance

prompted acceptance of surgery despite its associated discomfort and hazards.

The findings of the study are expected to be useful in better informing

clinical psychological interventions with aims of enhancing adjustment and

forestalling psychological morbidity through early intervention with individuals

coping with facial disfigurement.